Expert: Sally Wendkos Olds - 6/28/2004

Question
Hi I am currently stuggling through nursing my 2nd child.  Because my letdowns are so forceful he stuggles through, gulps lots of air and usually ends up screaming.  He is 3 months old and I have decided to switch to bottle feeding him the breastmilk.  Here is my question (s), how much do I start with 2oz / 4 ozs?  And if I warm up a 2 oz bag and then don't need it can I re-refrigerate it and rewarm at a later feeding?

Thanks,
Donna  

Answer
Dear Donna,

First of all, congratulations for giving your baby the best start in life by breastfeeding! And also congrats for having so much milk.

One way to handle your forceful letdown is to express a little milk first before putting your baby to the breast. You can save this in a sterile bottle, but it sounds as if you'll still have plenty of milk for your baby. I would try this before giving up the breastfeeding in favor of expressing all your precious milk into a bottle and depriving both you and your son of the emotional component of nursing at the breast.

For those feedings when you do give breast milk in a bottle, start with a 2-ounce bag. And no, you should not refrigerate and reheat milk that has been heated once. I'm putting below some information about storing and feeding breast milk. There's more in my book, THE COMPLETE BOOK OF BREASTFEEDING, 3rd edition (Eiger & Olds, 1999, Workman Publishing & Bantam Books), which is available in most public libraries, online & earthbound bookstores and La Leche League chapter libraries.

Good luck!

Sally Wendkos Olds
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     STORAGE TIMES FOR COLLECTED MILK
Basically, your collected breast milk will keep for several hours at room temperature if it's covered, it will keep in the refrigerator for about two days, and if you want to keep it longer than that, you should freeze it.
  The following guidelines should assure safety and maximum benefit to your baby.
  * To be given to baby within 30 minutes: No special storage needed. Can be kept at room temperature.
  * To be given to baby within 6 to 10 hours: Pour into clean container; cap tightly. You do not have to refrigerate the milk; human milk kept in a capped clean container does not grow bacteria, even at room temperature (66 to 72N F) because of its ability to slow the growth of bacteria. However, if the room temperature is higher than 72N, refrigerate it.
  * To be given to baby within 48 hours (2 days): Pour into clean container; cap tightly. Refrigerate at 40N F (4N C) or below.
  * To be given to baby within a week: Pour into clean container; cap tightly. Quick-cool in the refrigerator for 30 minutes. Then freeze in refrigerator-freezer unit.
  * To be given to baby within 1 to 2 weeks: Pour into sterile container; cap tightly. Quick-cool in the refrigerator for 30 minutes. Then freeze in refrigerator-freezer unit.
  * To be given to baby within 3 to 6 months: Pour into sterile container; cap tightly. Quick-cool in the refrigerator for 30 minutes. Then freeze at 0N F (-18N C) or below in the freezer of a two-door refrigerator or a deep freeze that is not opened often. Not all freezers stay cold enough for long-term storage. Check temperature with a freezer thermometer at different places in the unit. The freezer should maintain a constant temperature of 0N. If it keeps ice cream very solid, it is probably cold enough.
  If your freezer does not get this cold but does keep other frozen foods hard, keep the milk in the center of the freezer and use within three to four months. Frost-free refrigerators, which have a warming element, generally do not maintain 0N.
  To find out whether your milk thaws and then refreezes in your freezer, check by keeping an ice cube in a little jar; if you check it a day later and find that it has melted and refrozen, you'll know that this has probably happened to your milk, too. If so, you'll have to discard the milk.
  It's best to use milk soon after collecting it, and preferably within three months. For one thing, milk collected when your baby is two months old will not meet her needs as effectively when she is six months old.
  * Keeping breast milk longer than 6 months: This is not a good idea. While instructions are sometimes given for keeping frozen milk up to two years, long-term freezing alters the chemical composition of the milk. (Some of the fats break down, and the milk loses some of its ability to fight harmful organisms.) Furthermore, you run the risk of contamination if you lose electrical power during that time and the milk thaws and refreezes.
  * Do not refreeze milk that has defrosted. If frozen milk has started to thaw, refrigerate it immediately and use it within 12 hours.
     
DEFROSTING YOUR MILK AND FEEDING YOUR BABY
  * Avoid overnight thawing of milk.
  * Do not leave frozen milk out at room temperature.
  * About half an hour before feeding time take the container from the freezer and hold it under tepid running water. Gradually increase the temperature of the water to hot. Shake the bag or bottle gently as you warm it; this remixes the cream that has separated. (Since your milk is not homogenized, the fat rises to the top on standing. If you shake the milk too vigorously, you might turn this fat to butter.) It should take about four minutes to thaw four ounces of frozen milk. This method can also be used to heat refrigerated milk.
  * Do not heat either breast milk or formula in a microwave oven. Vitamins and other components in the milk may be destroyed, glass bottles may crack or explode, and hot spots may occur, which could cause severe burns to your baby's mouth or esophagus.
  * Do not heat milk on the stove if you can avoid it. First, there's a danger of overheating and destroying antibodies and nutrients. Second, there's the chance that frozen milk will curdle. And then there's the all-too common scenario of the mother or babysitter warming milk in a pan of water on the stove, running to answer the phone or the door -- and coming back to find the bottle or bag melted and the milk boiled into the bottom of the pan. No way to treat that liquid gold -- or the baby waiting for it.
  However, if you do not have running warm water, put a bottle in a pan with warm water. Heat on medium heat, do not let the water boil, and do not leave the kitchen. Test the milk on the inside of your elbow; you should barely be able to feel it. If it feels warm, let it cool down to body temperature before feeding your baby.
  * Roll or shake the bottle again gently before feeding.
  * Use milk that has been defrosted but not heated within 12 hours. If the milk has been heated, use within 30 minutes.
  * Discard any milk in the bottle that your baby does not finish at one feeding.
  * Do not refreeze defrosted milk. If you can't use it within the suggested time limit, throw it away. It's painful to have to discard what seems like such a precious resource, but this milk is no longer the "liquid gold" it was before. There is a possibility that it might make your baby sick.
  * If you have both fresh and frozen milk, give your baby the fresh milk and save the frozen for supplements and emergencies since freezing causes some loss of antibodies.